The goal of the Telehealth for Health study is the development and initial evaluation of an automated, telephone-based screening, referral, and educational behavioral intervention system with the long-term objective of promoting health by preventing secondary conditions and decreasing their severity among adult patients with mobility impairments (Ml) who are wheelchair users. This study forwards the goals of Healthy People 2010 Chapter 6 on Disability and Secondary Conditions. The target population will consist of people with spinal cord dysfunction, including people with spinal cord injury and people with multiple sclerosis at Boston Medical Center and affiliated institutions. The specific aims of the proposed study are: 1) To design and develop TLC-SCD that consists of: (a) a Pressure Ulcer Module which screens for new ulcers, promotes healthy prevention behaviors, and detects and monitors existing ulcers; (b) a Depression and Substance Use Module that will detect depressive symptoms and substance use problems and measure their severity; (c) a Health Care Utilization Module that inquires about individualized mental and physical health care utilization and misconceptions for targeted behavior change; and (d) a Community Integration Resource Module that provides referrals and resources. 2) To conduct a preliminary qualitative evaluation of the acceptability and usability of TLC-SCD by patients with SCO and to modify, improve, and refine TLC-SCD accordingly. 3) To conduct an initial randomized clinical trial (RCT) comparing TLC-SCD to a control condition (standard care) to evaluate its preliminary efficacy to promote the health of patients with SCO through prevention and detection of secondary conditions for treatment referral and behavioral intervention. Alerts to the nurse coordinator will occur whenever TLC-SCD detects a clinically significant event. A randomized clinical trial will be conducted to compare the TLC-SCD intervention to a control (no-intervention standard care) group. Participants in the intervention group will be called weekly for 3 months, followed by an observation period of 3 months, and will interact with the system through voice recognition technology. Such rigorous results will contribute greatly to developing and implementing low-cost, effective interventions for people with mobility impairments. [unreadable] [unreadable] [unreadable]